This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Tuesday, June 21, 2011

I Wonder What Will Come Out of the PCEHR Infrastructure Provider Tender? What Is to Be Done is Pretty Big!

Having now had a chance to have a browse of what is planned, based on the documents I pointed out a few days here:

It seems to me there are a few general points that can be made and some general conclusions that can be drawn.

The first is that the actual PCEHR system being proposed is BIG (Very Big) and COMPLEX. This was pretty clear when the April Version of the PCEHR ConOps was released but has now become clearer with the new document release.

The second conclusion - given that it seems unlikely a contract will be signed until early August or so (given how long these things always take!) - is that whatever is going to be delivered to meet the requirements will not be developed from the ground up - but rather take functionality that is already developed and proven and customise and localise it to suit the PCEHR requirements. Building this from the ground up would just take too long, although some of the more ‘twiddly bits’ might need a fair bit of local development!

The third conclusion is that overall the model being sought does fit well enough to make the US style Health Information Exchange a reasonable source of already standardised and possibly even open-source modules (as per the Connect Program being supported by the US Office of the Health IT Co-Ordinator - ONC).

If all this is about on the money then what the Tender will finally need to procure is a Design / Systems Integration Capability with access to as much of the base software capability as possible in the cleanest possible commercial way to suit Australian Government Contracting.

From here on you are left with some guess work. Who might prime this whole effort? My guess is that who-ever will need to be big and have a track record. This really means you are left with CSC, Fujitsu, Accenture, IBM, maybe Microsoft or Intersystems and then maybe some of the Australian SI houses with some capabilities in the health area - although the scale of this effort may just be too big for the time available.

On the basis the Tender closed on March 22, 2011 it is safe to assume that each of the major players has teamed up with a range of partners to provide all the capabilities requested. I have no idea what mix and matching will have happened behind the scenes, but you can be sure some clues are out there.

At least one of these is the following press release appeared a weeks ago.

Press Releases

Sydney, Australia and Tel Aviv, Israel, June 2, 2011 — dbMotion, an innovative provider of connected healthcare solutions, today announced its increased interest and consequent investment in the Australian Healthcare IT market.

“Over the last year we have experienced growing interest from Australian healthcare organisations, that are now actively seeking solutions that connect disparate systems to improve patient experiences and outcomes,” said Ilan Freedman, dbMotion’s Vice President Asia-Pacific. “This is happening across the market and has recently been illustrated by the Australian Federal Government launching the procurement of the PCEHR Solution”.

Working together with industry partners, dbMotion fulfils the vision of connected healthcare. dbMotion’s solution enables healthcare organisations and health information exchanges (HIEs) to meaningfully integrate and leverage their information assets by placing an integrated patient record within clinical workflows. dbMotion closes information gaps between caregivers, enhances decision-making and drives improvements in the quality and efficiency of patient care.

Looking at the Tender requirements with the newly released documents there is no doubt someone is going to be attempting to do in very short order what has taken other countries many years.

Frankly, even with a range of already developed software, this is going to be a huge ask. Also remember with the drop-dead date of June 30, 2012 they are going to have to let us know pretty soon who is doing what and with whom. To delay makes the chances of delivery increasingly unlikely.

Remember it is not really all the technology but the people, process and change management that is going to be the trick here - and I am not sure delivering the technology is going to be anywhere near enough to make the PCEHR a success. The adoption, change management and clinician engagement issues are going to rank right up there!

We can all watch and wait I guess! Frankly it will be all guesswork until some formal announcements are made - hopefully reasonably soon!

Accenture based on Singapore will buddy up with Orion and Oracle, fly in their heavyhitters from the US and Europe to convince DOHA they know eHealth. Pretend the catalogue of failures and walking away in their past is just that - in the past. Of course, if they do win they'll rapidly replace their heavy hitters with college graduates who have no idea.

Fujitsu will try to pretend they have a big health practice in Australia based on what they do with HealthSmart in Victoria - and a wonderful track record that is. They'll probably team up with Orion too or maybe Intersystems.

CSC will play the "we're the biggest system integrator in healthcare" card which they bored us with over dinner at HIC last year. I wonder if they still are the biggest, considering the UK governments cancellation of many of their contracts for non-delivery. Who knows, maybe they'll work Orion too but they recently did a deal with Microsoft Amalga in Chicago so maybe thats where Microsoft goes.

IBM, well, they're probably quite happy creaming a fortune for the yet-to-exist NASH and the yet-to-be-used Identifiers service. But they work with dbMotion a lot in the US and Canada, so that's probably the connection and why dbMotion is putting press releases in the Australian media.

The sad thing is they're all just as complicit in this debacle, leading DOHA to believe that their fanciful plan cooked up by NEHTA without an ounce of common sense or practicality, is actually deliverable in the insane timeframe and manner set out.

Yes, minister, anything you say, minister - now can I have my cheque please?

Clearly not even a look in for the local medical software industry who instead will have to stomach the cost of attaining an absurd level of specification conformance.

In reality though, when people finally see that the PCEHR emperor has no clothes, it will be the small players of the medical software industry locally - organisations like DCA, Icare, Kestral, LRS, Medical Objects, Ocean, PEN, Smart Health and the hundred other small health IT vendors that have scraped by for years who will have to pick up the pieces and soldier on without either funding or backing.

$467 million is a lot of money - enough to bring the big game hunters of the industry to town. But it also distorts and abuses the market in a way that is wholly unfair. Sadly, just as the majority of the 5 years of NEHTA's funding so far has been wasted, so will the next year of funding be wasted on expensive consultant yes-men who deliver hollow truths and slink away when they fail.

Don't know much about what Fujitsu or CSC are up to - you (anonymous #2) might be spot on. I know a little about Accenture and IBM.Accenture will do as you “guessed” - try hide their colossal failures and ”walk-outs” elsewhere, bring in their big names and then do the famous Accenture switching act (and scope changes) as they bring in juniors to do the work or to manage work done off-shore in India. They are already trying to leverage the Singapore “success”. From what I hear, it’s anything but a success – but both Accenture and the Singapore client have a common interest to make it look like one, so I wonder if the PCEHR evaluators have any chance at seeing past the show will orchestrated for them.I hear that IBM are going in with their own technologies (which I think would rule out working with dbMotion as I have heard that it’s a Microsoft based solution). One can only speculate that they are very confident that NEHTA/DOHA are eating out of the palm of their hand after NASH and are trying to maximize their share of wallet by sticking to IBM technologies and not sharing the $$$ with too many partners. Not sure I know where dbMotion fit in the equation; they probably have the most solid solution out there – so maybe they are playing with a local vendor or some dark horse. Axolotl and Medicity were recently gobbled up by US insurance focused organizations and in any case were US-only companies – so I doubt if we’ll see them here. As to Microsoft and Oracle, Amalga is disappearing (even Microsoft are starting to understand that it won’t deliver) and has very little to do with the PCEHR requirements and Oracle have HTB which is so rigid and generic that it’s hard to see how a unique solution like PCEHR could be accommodated by it.

You would have known it wasn't me by the facts:1. That it is an Anon posting something I do not do; and2. That my employer (HealthLink) was not in the listed organisations that will pick up the pieces if the scenario pans out as described and will get the job done.

There are some valid points that Anon #2 makes in my opionion and plots a possible pathway of events.

I have expressed views in other forums and articles in Pulse-IT that have raised similar concerns re the long term viability of the program of eHealth and being outcome foucsed on delivering lasting benefits.

PS The MSIA pool of talent and ever increasing list of member companies is a lot deeper than a puddle - more like a lake - there are plenty of fish out there - just trying to stay away from the sharks that are looking for some easy prey :)